Examples
|
| betamethasone | Celestone |
| dexamethasone | |
| hydrocortisone | Cortef |
| methylprednisolone | Depo-Medrol, Medrol |
| prednisone | |
Depending on the drug, steroids may be given
intravenously, as pills, as an injection, or applied
to the skin in a cream or ointment.
High doses of prednisone may
be used for short periods of time. The dose is then gradually reduced.
Why It Is Used
Corticosteroids are used to control
moderate to severe problems caused by lupus, including inflammation, pain, and
tissue damage throughout the body.
Low-dose corticosteroids may be
used to treat:
- Joint or muscle pain, skin rash, fatigue,
fevers, and other symptoms that affect your quality of life and are not
relieved by nonsteroidal anti-inflammatory drugs (NSAIDs) or antimalarials.
- Severe skin
rashes, which may respond to steroid creams or ointments, shots, or pills.
However, the skin symptoms may return when you stop using the steroid.
High-dose corticosteroids are used to treat severe or
life-threatening problems including:
High-dose corticosteroids may also ease
central nervous system symptoms such as severe
headache, confusion, and nerve damage that causes problems with
movement.
How Well It Works
Corticosteroids often dramatically
improve many symptoms of lupus. Some conditions respond in as little as a few
days, while others may take several weeks of corticosteroid therapy.1
The
effects of corticosteroids can include:
- Decreased pain in joints and
muscles.
- Decreased pain and inflammation from skin
rashes.
- Decreased inflammation in blood vessels and in the tissues
surrounding the heart and lungs.
- Decreased central nervous system
symptoms, such as severe headaches and confusion.
Corticosteroids are often combined with other drugs such as mycophenolate mofetil, or
cyclophosphamide with or without azathioprine.
Corticosteroids are prescribed and monitored carefully because they cause
significant side effects.
Side Effects
Corticosteroids cause a wide variety of
side effects, some of which can be severe. The risk of side effects is
especially high when corticosteroids are taken in high doses for long periods
of time. There are times when it can be difficult to distinguish between
corticosteroid side effects and lupus symptoms, such as fatigue or joint pain.
Most common and reversible corticosteroid
side effects:
- Swelling caused by fluid retention
(edema)
- Weight gain
- Rounding of facial
features
- Mood swings, difficulty concentrating,
insomnia,
anxiety, and euphoria
- Easy
bruising
- Increased risk of infection from immune
suppression
- Elevated blood pressure
- Gastritis,
peptic ulcer
- Problems with blood sugar
levels (diabetes)
- Muscle
weakness
- Glaucoma
Common and irreversible
corticosteroid side effects:
Uncommon and irreversible
corticosteroid side effects:
- Thinning or destruction of the bone, most
often at the hip joint (osteonecrosis)
- Cataracts
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
What To Think About
If your main symptoms are pain,
fatigue, or fever, many experts consider it best to avoid the side effects of
steroids and try to control your symptoms with other medication, such as NSAIDs
or antimalarials.
It is common to try to find a maintenance dose
of steroids (taken daily or on alternate days) that is low enough to avoid
serious side effects but high enough to control symptoms. You may start at a
higher dose and then reduce the dose gradually after your symptoms have been
controlled. If the dose that controls symptoms causes unacceptable side
effects, another medication may also be used, such as an antimalarial or
immunosuppressant.
To prevent osteoporosis while taking long-term
corticosteroids, get plenty of
calcium and
vitamin D, and consider a preventive medicine, such as
alendronate or risedronate. To come up with a plan that fits your needs, you
may want to work with your doctor or a
registered dietitian. Weight-bearing exercise also
helps reduce the risk of osteoporosis. For more information, see the topic
Osteoporosis.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
- Crow MK (2008). Systemic lupus erythematosus. In L
Goldman, D Ausiello, eds., Cecil Textbook of Medicine,
23rd ed., pp. 2022–2032. Philadelphia: Saunders Elsevier.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Stanford M. Shoor, MD - Rheumatology |
|---|
| Last Revised | May 7, 2010 |
|---|
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